In-vitro development of an effective treatment for Acanthamoeba keratitis.

The aim of this study was to develop an in-vitro topical treatment for Acanthamoeba keratitis (AK) effective against cysts and trophozoites. Qualitative assays were performed with voriconazole, chlorhexidine, propamidine, cellulase, tobramycin, ciprofloxacin and paromomycin as monotherapy and various combinations. Riboflavin with ultraviolet-A (R + UV-A) as monotherapy or combined with voriconazole and moxifloxacin was also tested. Quantitative assays to assess cyst viability after treatment were performed for the chemicals that showed the highest activity in the qualitative assays. Paromomycin and propamidine did not show antiamoebic activity. Regardless of the total dose, no amoebicidal effect was observed for R + UV-A. Tobramycin, ciprofloxacin, voriconazole, chlorhexidine and cellulase were selected for quantitative assays because they appeared to cause greater damage to the structure of amoebae. Chlorhexidine and ciprofloxacin were the most active against Acanthamoeba spp. as monotherapy. Among the combinations evaluated, ciprofloxacin-voriconazole-chlorhexidine showed the greatest amoebicidal activity, with severe damage of the cellular membrane and an important decrease in cell concentration. In summary, ciprofloxacin as monotherapy and in combination with voriconazole and chlorhexidine has been classified as promising treatment. Additional in-vivo studies in animal models and clinical trials in patients with AK should be considered to confirm the efficacy of ciprofloxacin.

A numerical-experimental protocol to characterize corneal tissue with an application to predict astigmatic keratotomy surgery.

Tonometers are intended to determine the intraocular pressure (IOP) and the quality of corneal tissue. In contrast to the physiological state of stress of the cornea, tonometers induce non-physiological bending stress. Recently, the use of a single experiment to calibrate a set of corneal mechanical properties was suggested to be an ill-posed problem. Thus, we propose a numerical-experimental protocol that uses inflation and indentation experiments simultaneously, restricting the optimization space to circumvent the ambiguity of the fitting. For the first time, both corneal behaviors, i.e., biaxial tension (physiological) and bending (non-physiological), are taken into account. The experimental protocol was performed using an animal model (New Zealand rabbit's cornea). The patient-specific geometry and IOP were registered using a MODI topographer (CSO, Italy) and an applanation tonometer, respectively. The mechanical response was evaluated using inflation and indentation experiments. Subsequently, the optimal set of material properties is identified via an inverse finite element method. To validate the methodology, an in vivo incisional refractive surgery (astigmatic keratotomy, AK) is performed on four animals. The optical outcomes showed a good agreement between the real and simulated surgeries, indicating that the protocol can provide a reliable set of mechanical properties that enables further applications and simulations. After a reliable ex vivo database of inflation experiments is built, our protocol could be extended to humans.

[Intravitreal ranibizumab in the treatment of subretinal neovascularization in a case of punctate inner choroidopathy]. / Ranibizumab intravítreo en el tratamiento de membrana neovascular subretiniana en un caso de coroidopatía puntata interna.

CASE REPORT: We report the case of a 28-year old woman suffering loss of visual acuity in her left eye, who presented an image suggestive of a subretinal neovascular membrane in her left eye, and bilateral retinal lesions compatible with punctate inner choroidopathy (PIC). She was treated with intravitreal ranibizumab obtaining excellent results. DISCUSSION: The differential diagnosis must be made between PIC and the rest of "white dot syndromes" and the presumed ocular histoplasmosis syndrome (POHS). Antiangiogenic drugs may be a good alternative for the treatment of such diseases when they develop a subretinal neovascular membrane.

Utilidad de las retinografías en el diagnóstico del edema macular diabético / Use of retinal photography in the diagnosis of diabetic macular edema

Objetivo: Determinar la validez de las retinografías en el diagnóstico del edema macular diabético. Fijar el número y amplitud de las fotografías necesarias para su correcto diagnóstico. Métodos: Estudio observacional transversal constituido por 650 ojos de pacientes con retinopatía diabética, a los que se realizó una combinación de retinografías (simples, estereoscópicas y luz aneritra), previa dilatación, para determinar su validez, en el diagnóstico del edema macular diabético. Se calcularon sensibilidad, especificidad, valores predictivo positivo y negativo, así como la concordancia con la prueba de referencia (tomografía de coherencia óptica). Las fotografías fueron evaluadas por tres expertos y sus resultados analizados con el programa estadístico SPSS 15.0 Windows. Resultados: Se obtuvieron valores de sensibilidad inferiores al 80% en el caso de fotografías simples, superando el 80% las retinografías estereoscópicas o aquellas que asocian filtros verdes, siendo la fotografía estereoscópica verde a 30° la que alcanzó mayor sensibilidad, próxima al 94,3%. La especificidad fue del 95% en el caso de fotografías estereoscópicas en color y aneritra a 45 y 30°, respectivamente. El valor predictivo positivo superior al 95% y negativo del 90% con un coeficiente de acuerdo del 80% y un grado de concordancia con la prueba de referencia superior al 80%. Conclusiones: Las retinografías estereoscópicas ofrecen resultados suficientes, como para ser utilizadas en el cribado del edema macular diabético. La utilización de filtros verde (luz aneritra) y su combinación con la agudeza visual mejora los resultados en el diagnóstico de esta enfermedad (AU)

Objective: To determine the validity of retinal photography in the diagnosis of diabetic macular edema. Determine the number and size of the photographs for its correct diagnosis. Methods: Cross-sectional observational study consisting of 420 eyes of patients with diabetic retinopathy, using a combination of retinography (simple, stereoscopic, red-free light), after expansion, to determine its validity in the diagnosis of diabetic macular edema. Sensitivity, specificity, positive and negative predictive values and the correlation with the gold standard test (optical coherence tomography) were calculated. The retinographs were evaluated by three experts and their results analyzed by the statistical program SPSS 15.0 Windows. Results: Sensitivities were below 80% in simple photographs and above 80% in the stereoscopic retinography, whereas those associated with red-free filters, reaching the 30° green stereoscopic photography, showed a sensitivity of 94.3%. The specificity was 95% in color and red-free stereoscopic retinography of 45° and 30°. The positive predictive value was greater than 95% and the negative value greater than 90% with a coefficient of agreement of 80%, and a degree of consistency with the benchmark of over 80%. Conclusions: The results of the stereoscopic retinographs are sufficient to enable them to be used in screening for diabetic macular edema. The use of a green filter and its combination with visual acuity improves results in the diagnosis of this disease (AU)

[Use of retinal photography in the diagnosis of diabetic macular edema]. / Utilidad de las retinografías en el diagnóstico del edema macular diabético.

OBJECTIVE: To determine the validity of retinal photography in the diagnosis of diabetic macular edema. Determine the number and size of the photographs for its correct diagnosis. METHODS: Cross-sectional observational study consisting of 420 eyes of patients with diabetic retinopathy, using a combination of retinography (simple, stereoscopic, red-free light), after expansion, to determine its validity in the diagnosis of diabetic macular edema. Sensitivity, specificity, positive and negative predictive values and the correlation with the gold standard test (optical coherence tomography) were calculated. The retinographs were evaluated by three experts and their results analyzed by the statistical program SPSS 15.0 Windows. RESULTS: Sensitivities were below 80% in simple photographs and above 80% in the stereoscopic retinography, whereas those associated with red-free filters, reaching the 30° green stereoscopic photography, showed a sensitivity of 94.3%. The specificity was 95% in color and red-free stereoscopic retinography of 45° and 30°. The positive predictive value was greater than 95% and the negative value greater than 90% with a coefficient of agreement of 80%, and a degree of consistency with the benchmark of over 80%. CONCLUSIONS: The results of the stereoscopic retinographs are sufficient to enable them to be used in screening for diabetic macular edema. The use of a green filter and its combination with visual acuity improves results in the diagnosis of this disease.

[Effects of encircling scleral buckling on the morphology and biomechanical properties of the cornea]. / Efecto del cerclaje escleral en la cirugía vítreo-retiniana sobre la morfología y biomecánica de la córnea.

OBJECTIVE: To investigate the effects of encircling scleral buckle (SB) on corneal biomechanical properties of the cornea and its morphological parameters. METHODS: We prospectively examined twelve eyes diagnosed with vitreous haemorrhage undergoing pars plana vitrectomy (PPV), and fifteen eyes undergoing combined PPV and scleral buckle (PPV/SB) for repair of rhegmatogenous retinal detachment (RRD). Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with an Ocular Response Analyser (ORA) before and 1-month postoperatively. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). Finally, four morphological parameters of the cornea were measured with the Orbscan II topographer (Orbtek, Inc.): mean corneal power, thinnest corneal point (µm), and anterior chamber depth (ACD). RESULTS: CH decreased significantly from 10.2+/-1.7mmHg to 7.6+/-1.1mmHg after PPV/SB (p=0.003), but not after PPV alone (9.8+/-3.2mmHg vs 11.6+/-2.7mmHg, P=.465). CRF did not change significantly after surgery in both groups. IOPg and IOPcc increased significantly in the PPV/SB group (P=.019 and P=.010, respectively) but not in PPV group (P=.715 and P=.273, respectively). Unlike the PPV group, values were significantly higher than IOPg values before (P=.001) and after surgery (P=.003) in the PPV/SB group IOPcc. Neither the PPV/SB group nor the PPV group showed any significant changes in the corneal morphological parameters after surgery (P>.05). CONCLUSIONS: SB surgery leads to a change in the corneal biomechanical properties without altering corneal morphological parameters. It may cause an underestimation error in IOP measurement. PPV may be a less invasive surgical approach for the repair of noncomplex RRD than PPV/SB.

Efecto del cerclaje escleral en la cirugia vitreo-retiniana sobre la morfologia y biomecanica de la cornea / Effects of encircling scleral buckling on the morphology and biomechanical properties of the cornea

Objetivo: Valorar los efectos del cerclaje escleral en cirugía vitreo-retiniana, sobre la biomecanica y morfologia del segmento anterior. Metodos: Estudio prospectivo: 15 ojos con desprendimiento de retina (DR), sometidos a vitrectomía pars plana (VPP) implante de cerclaje escleral (grupo 1), y 12 ojos con hemorragia vítrea sometidos a VPP aislada (grupo 2). Se compararon pre y postoperatoriamente las propiedades biomecánicas corneales, mediante Ocular Response Analyzer (ORA): histéresis corneal (CH) y factor de resistencia corneal (CRF), ademas de presión intraocular Goldmann (PIOg) y presión intraocular compensada (PIOcc). Se investigó su relación con 4 parámetros morfológicos obtenidos con Orbscan IIz: potencia media de K (Mean power), desviación estándar (DE), mínimo espesor corneal (Thinnest) y profundidad de cámara anterior (ACD). Resultados: CH descendió de 10,2+/-1,7mmHg a 7,6+/-1,1 en el grupo 1 (p=0,003), pero no en el grupo 2 (9,8+/-3,2 vs 9,6+/-2,7, p=0,465). No hubo cambios en el CRF tras la cirugíaa. PIOg y PIOcc aumentaron significativamente en el grupo 1 (p=0,019 y p=0,010 respectivamente), pero no en el grupo 2 (p=0,715 y p=0,273). No hubo cambios significativos en los parámetros topográficos en ambos grupos (p> 0,05). Test de Wilcoxon. Conclusiones: El cerclaje escleral en la cirugía del DR no modifica significativamente la morfología del segmento anterior, luego la miopización generada se debería exclusivamente a la elongación axial del segmento posterior. La biomecánica corneal sí se altera, disminuyendo la CH. Se aporta un argumento más a favor de la VPP aislada en estas cirugías, que supondría una técnica menos agresiva quirúrgicamente(AU)

Objective: To investigate the effects of encircling scleral buckle (SB) on corneal biomechanical properties of the cornea and its morphological parameters. Methods: We prospectively examined twelve eyes diagnosed with vitreous haemorrhage undergoing pars plana vitrectomy (PPV), and fifteen eyes undergoing combined PPV and scleral buckle (PPV/SB) for repair of rhegmatogenous retinal detachment (RRD). Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with an Ocular Response Analyser (ORA) before and 1-month postoperatively. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). Finally, four morphological parameters of the cornea were measured with the Orbscan II topographer (Orbtek, Inc.): mean corneal power, thinnest corneal point (micro metro), and anterior chamber depth (ACD). Results: CH decreased significantly from 10.2+/-1.7mmHg to 7.6+/-1.1mmHg after PPV/SB (p=0.003), but not after PPV alone (9.8+/-3.2mmHg contra 11.6+/-2.7mmHg, P=.465). CRF did not change significantly after surgery in both groups. IOPg and IOPcc increased significantly in the PPV/SB group (P=.019 and P=.010, respectively) but not in PPV group (P=.715 and P=.273, respectively). Unlike the PPV group, values were significantly higher than IOPg values before (P=.001) and after surgery (P=.003) in the PPV/SB group IOPcc. Neither the PPV/SB group nor the PPV group showed any significant changes in the corneal morphological parameters after surgery (P>.05). Conclusions: SB surgery leads to a change in the corneal biomechanical properties without altering corneal morphological parameters. It may cause an underestimation error in IOP measurement. PPV may be a less invasive surgical approach for the repair of noncomplex RRD than PPV/SB(AU)

[Diagnosis of systemic disease after bilateral retinal arterial macroaneurysm]. / Diagnóstico de patología sistémica tras macroaneurisma arterial retiniano bilateral.

CASE REPORT: An 85 year old male suffered vision loss in both eyes due to ruptured bilateral retinal arterial macroaneurysms. DISCUSSION: We report this unusual case and show the importance of studying these types of patients in order to detect associated systemic diseases.

Diagnóstico de patología sistémica tras macroaneurisma arterial retiniano bilateral / Diagnosis of systemic disease after bilateral retinal arterial macroaneurysm

Caso clínico: Un varón de 85 años sufrió pérdida de visión en ambos ojos debido a la roturade macroaneurismas arteriales retinianos bilaterales.Discusión: Se comenta este caso inusual y hablamos de la importancia de estudiar a estospacientes para detectar enfermedades sistémicas asociadas(AU)

Case report: An 85 year old male suffered vision loss in both eyes due to ruptured bilateralretinal arterial macroaneurysms.Discussion:We report this unusual case and show the importance of studying these types ofpatients in order to detect associated systemic diseases(AU)

[Spontaneous closure of full thickness traumatic macular holes]. / Cierre espontáneo de agujeros maculares traumáticos de espesor completo.

CASE REPORT: We present case reports of two young patients suffering from full thickness traumatic macular holes resulting in visual impairment of more than 60%. Both showed anatomical and visual improvement whilst waiting for surgical treatment. DISCUSSION: Spontaneous closure of a traumatic macular hole is an unusual outcome. OCT and clinical follow up enabled monitoring of this resolution during a period of a few weeks. Complex surgery was thus avoided by a short observational period.

[Bilateral optic nerve infiltration in acute lymphoblastic leukemia in remission]. / Infiltración bilateral del nervio óptico en un caso de leucemia aguda linfoblástica de células T en remisión.

CASE REPORT: An 18-year-old male affected by acute lymphoblastic leukemia (ALL) after having reached complete remission after chemotherapy developed bilateral optic nerve infiltration. DISCUSSION: Infiltration of the optic nerve may appear as an isolated sign of extramedullary relapse of ALL months in advance of the hematologic relapse.

[Eyelid contact allergic eczema caused by topical ketorolac tromethamine 0.5%]. / Eccema alérgico de contacto palpebral por ketorolaco trometamol 0,5% tópico.

CLINICAL CASE: A 65-year-old man had been treated with eye-drops containing NSAIDs (Ketorolac). He developed conjunctival injection, edematous swelling of the eyelids and periorbital dermatitis due to a contact allergy. Allergy to NSAIDs is uncommon. DISCUSSION: This is an unusual case because topical application of ketorolac is safe in the vast majority of ophthalmologic patients. However adverse events associated with Ketorolac are similar to that of other NSAIDs.

Eccema alérgico de contacto palpebral por ketorolaco trometamol 0.5% tópico / Eyelid contact allergic eczema caused by topical ketorolac tromethamine 0.5%

Caso clínico: Hombre de 65 años que había sidotratado con AINE tópico (Ketorolaco). El pacientepresentó inyección conjuntival, edema de párpados,y dermatitis periorbitaria por eccema alérgico decontacto secundario a AINE, un hecho raro en estetipo de tratamiento.Discusión: Este es un caso raro, ya que la aplicaciónde Ketorolaco tópico es seguro en la mayoríade los pacientes oftalmológicos. Además, las reaccionesadversas asociadas con el Ketorolaco sonsimilares a otros AINES

Clinical case: A 65-year-old man had been treated with eye-drops containing NSAIDs (Ketorolac). He developed conjunctival injection, edematous swelling of the eyelids and periorbital dermatitis due to a contact allergy. Allergy to NSAIDs is uncommon. Discussion: This is an unusual case because topical application of ketorolac is safe in the vast majority of ophthalmologic patients. However adverse events associated with Ketorolac are similar to that of other NSAIDs

[Intraocular lenses with blue light filter]. / Lentes intraoculares con filtros para luz azul.

PURPOSE: To evaluate if a SN60AT <> IOL (Alcon) with IMPRUV filter (Alcon) offers any advantage in patients having cataract surgery, as compared with Acrysof SA60 IOL (Alcon). METHODS: This was a prospective analytical study. We studied sixty-four eyes from 32 patients with cataracts. After a random assignment, phacoemulsification with the implant was performed using the Acrysof SN60AT tinted lens in one eye and Acrysof SA60 in the other. A variety of variables was subsequently assessed: contrast sensitivity with a CSV 1000E test, colour perception through a Farnsworth 25 test and subjective measures by a patient survey. Differences between the groups were assessed statistically. RESULTS: The contrast sensitivity results were obtained for 3, 6, 12 and 18 cycles per degree (cpd) frequencies under scotopic conditions, with better results obtained following the use of SN60AT: 0.75 (CSV 1000E test units) for 3 cpd, 0.86 for 6 cpd, 0.54 for 12 cpd and 0.35 for 18 cpd. The differences were statistically significant between the two groups for 3 cpd and 6 cpd. A total of 62.5% of patients using a tinted lens and 50% with SA60 achieved good results in the Farnsworth test; 12.5% and 21% had fair results and 25% and 28.1% respectively had poor results. CONCLUSIONS: We obtained an improvement in favour of the tinted lens for all frequencies, with this being statistically significant at lower frequencies (3 and 6 cpd). No significant differences in the Farnsworth test performance or in the patient survey were found. The tinting provided by the IMPRUV filter brings an increase in contrast sensitivity without affecting colour perception.

Lentes intraoculares con filtros para luz azul / Intraocular lenses with blue light filter

Objetivo: Comparar si la lente intraocular SN60AT «Natural»® (Alcon), con filtro IMPRUV® (Alcon), aporta mejorías en la visión de los pacientes intervenidos de catarata con respecto a la Acrysof SA60® (Alcon).Métodos: Estudio prospectivo analítico, sobre treinta y dos pacientes (64 ojos) que presentaban catarata. Se realizó facoemulsificación con implante, tras un método de asignación aleatorio, de una lente Acrysof SN60AT (Natural) en un ojo y en el ojo contralateral de una Acrysof SA60. Determinamos diferencias entre ambas lentes para las variables de sensibilidad al contraste (CSV 1000E®. Vistech), percepción de los colores (Farnsworth 25) y una valoración subjetiva por el paciente a través de una encuesta.Se realizó un estudio estadístico para comparación de ambas muestras.Resultados: Los resultados de sensibilidad al contraste se obtuvieron para las frecuencias de 3, 6, 12 y 18 ciclos por grado (cpd) en condiciones escotópicas obteniendo una diferencia a favor de SN60AT de 0,75 (unidades de test del CSV 1000E) para 3 cpd, 0,86 para 6 cpd, 0,54 para 12 cpd y 0,35 para 18 cpd, siendo estadísticamente significativa esta diferencia en el caso de las dos primeras.Un 62,5% de pacientes con lente tintada y un 50% de los pacientes con SA60 realizaron el test de Farnsworth 25 con buen resultado, un 12,5% y un 21% regular, y un 25% y un 28,1% mal.Conclusiones: Hemos obtenido una mejora para todas las frecuencias a favor de la lente tintada, siendo estadísticamente significativas para las frecuencias bajas (3 y 6 cpd.)No hemos apreciado diferencias significativas en la realización del test de Farnsworth, ni el paciente las refiere a través del test subjetivo.La tinción que supone la adición del filtro IMPRUV® (Alcon), conlleva un aumento en la sensibilidad al contraste sin consecuencias para la percepción de los colores

Purpose: To evaluate if a SN60AT «Natural»® IOL (Alcon) with IMPRUV filter ®(Alcon) offers any advantage in patients having cataract surgery, as compared with Acrysof SA60® IOL (Alcon).Methods: This was a prospective analytical study. We studied sixty-four eyes from 32 patients with cataracts. After a random assignment, phacoemulsification with the implant was performed using the Acrysof SN60AT tinted lens in one eye and Acrysof SA60 in the other. A variety of variables was subsequently assessed: contrast sensitivity with a CSV 1000E test, colour perception through a Farnsworth 25 test and subjective measures by a patient survey. Differences between the groups were assessed statistically.Results: The contrast sensitivity results were obtained for 3, 6, 12 and 18 cycles per degree (cpd) frequencies under scotopic conditions, with better results obtained following the use of SN60AT: 0.75 (CSV 1000E test units) for 3 cpd, 0.86 for 6 cpd, 0.54 for 12 cpd and 0.35 for 18 cpd. The differences were statistically significant between the two groups for 3 cpd and 6 cpd.A total of 62.5% of patients using a tinted lens and 50% with SA60 achieved good results in the Farnsworth test; 12.5% and 21% had fair results and 25% and 28.1% respectively had poor results.Conclusions: We obtained an improvement in favour of the tinted lens for all frequencies, with this being statistically significant at lower frequencies (3 and 6 cpd).No significant differences in the Farnsworth test performance or in the patient survey were found. The tinting provided by the IMPRUV filter brings an increase in contrast sensitivity without affecting colour perception

Combination of Nd:Yag laser-induced subconjunctival bleeding and intracameral viscoelastic injection to treat hypotony maculopathy.

A 38-year-old man with primary open-angle glaucoma who had undergone trabeculectomy with mitomycin-C developed macular folds consistent with hypotony maculopathy. The patient was successfully treated with a combination of Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser-induced subconjunctival bleeding and injection of a viscoelastic substance into the anterior chamber. The combination of Nd:YAG laser-induced subconjunctival bleeding with intracameral viscoelastic injection appears to be a reasonable alternative to autologous blood injection and may be tried as first-line treatment for hypotony maculopathy caused by overfiltration.

Progressive external ophthalmoplegia: a paraneoplastic manifestation of lymphoma.

PURPOSE: Paraneoplastic neurological syndromes are well-known sequelae of some malignancies. To our knowledge, a syndrome mimicking progressive external ophthalmoplegia had never been reported preceding the diagnosis of a lymphoma. CASE REPORT: A 63-year-old man developed progressive external ophthalmoplegia, without any other neurological symptoms, as the initial manifestation of a follicular lymphoma grade III. The ophthalmoplegia resolved after two cycles of combination chemotherapy. CONCLUSIONS: The ophthalmologist, when confronted with a progressive external ophthalmoplegia, should consider a neurological paraneoplastic syndrome associated with a tumor as a possible diagnosis.

[Cognitive evoked potential in primary wide angle glaucoma]. / Potencial evocado cognitivo en el glaucoma primario de ngulo abierto.

INTRODUCTION: Primary wide angle glaucoma (PWAG) is the commonest form of this disorder. It is initially asymptomatic, until there has been considerable visual field loss. Personality changes have been described in patients with wide angle glaucoma, with a significant percentage of developing dementia or a tendency to react defensively. The P300 endogenous evoked potential is related to memory/attention to work. INTRODUCTION: To evaluate, in PWAG, the probable occurrence of a disorder of visual processing due to alteration in the attention/working memory and its neuronal network, using the P300 visual cognitive evoked potential in correlation with Lobo s cognitive mini exam (CME). PATIENTS AND METHODS: We selected 68 patients with PWAG and 68 controls, of both sexes, aged between 50 and 65 years. The CME was done after taking the clinical history, and then an electroretinogram, visual evoked potential using the alternating dameres (ERGd and VEPd) and P300 potential (passive odd ball). Statistical analysis was done using the t test, one way ANOVA and discriminating analysis. RESULTS: The amplitude on ERGd and latency on VEPd were significantly altered. Patients with glaucoma had lower scores on CME. Regarding the P300 wave, latency was the most significant parameter, whilst the amplitude and site were less well defined. PATIENTS AND METHODS: In PWAG a process of visual cognitive dysfunction occurs and affects memory/attention to work in a way which is not only due to the peripheral visual effect.